Association between educational attainment and thyroid cancer: evidence from a univariable and multivariable Mendelian randomization study.

BACKGROUND: Thyroid cancer and educational attainment have been related in observational studies. It is unclear if these correlations indicate causative relationships. METHODS: Using large-scale genome-wide association studies (GWAS) datasets, we conducted an univariable and multivariable Mendelian randomization (MR) study to assess a potential connection between educational attainment and thyroid cancer. The inverse-variance weighted (IVW) analysis method is used as our primary outcome. Additionally, we carry out several sensitivity analyses to evaluate the pleiotropy and robustness of the causal estimates. RESULTS: Univariate MR study shows 4.2 years of additional education is associated with a 41.4% reduction in thyroid cancer risk (OR = 0.586; 95% CI: 0.378-0.909; P = 0.017). Further multivariable MR analysis revealed that body mass index (BMI) acted as a partial mediating factor in the protective impact of higher educational attainment against thyroid cancer. CONCLUSION: This MR study provided genetic evidence that longer education attainment is related to a lower risk of thyroid cancer. Strategies of expanding education may reduce the burden of thyroid cancer in the world.

Association of major depression, schizophrenia and bipolar disorder with thyroid cancer: a bidirectional two-sample mendelian randomized study.

BACKGROUND: Major depressive disease (MDD), schizophrenia (SCZ), and bipolar disorder (BD) are common psychiatric disorders, and their relationship with thyroid cancer has been of great interest. This study aimed to investigate the potential causal effects of MDD, SCZ, BD, and thyroid cancer. METHODS: We used publicly available summary statistics from large-scale genome-wide association studies to select genetic variant loci associated with MDD, SCZ, BD, and thyroid cancer as instrumental variables (IVs), which were quality controlled and clustered. Additionally, we used three Mendelian randomization (MR) methods, inverse variance weighted (IVW), MR-Egger regression and weighted median estimator (WME) methods, to estimate the bidirectional causal relationship between psychiatric disorders and thyroid cancer. In addition, we performed heterogeneity and multivariate tests to verify the validity of the IVs. RESULTS: We used two-sample bidirectional MR analysis to determine whether there was a positive causal association between MDD and thyroid cancer risk. The results of the IVW analysis (OR = 3.956 95% CI = 1.177-13.299; P = 0.026) and the WME method (OR = 5.563 95% CI = 0.998-31.008; P = 0.050) confirmed that MDD may increase the risk of thyroid cancer. Additionally, our study revealed a correlation between genetic susceptibility to SCZ and thyroid cancer (OR = 1.532 95% CI = 1.123-2.088; P = 0.007). The results of the WME method analysis based on the median estimate (OR = 1.599 95% CI = 1.014-2.521; P = 0.043) also suggested that SCZ may increase the risk of thyroid cancer. Furthermore, our study did not find a causal relationship between BD and thyroid cancer incidence. In addition, the results of reverse MR analysis showed no significant causal relationships between thyroid cancer and MDD, SCZ, or BD (P > 0.05), ruling out the possibility of reverse causality. CONCLUSIONS: This MR method analysis provides new evidence that MDD and SCZ may be positively associated with thyroid cancer risk while also revealing a correlation between BD and thyroid cancer. These results may have important implications for public health policy and clinical practice. Future studies will help elucidate the biological mechanisms of these associations and potential confounders.

The effect of micronutrient on thyroid cancer risk: a Mendelian randomization study.

Background: The effect of micronutrients on thyroid cancer has been studied in observational studies, however, the cause of relationships has not yet been determined. Thyroid cancer was the subject of a Mendelian randomization (MR) analysis of micronutrients. Aimed to determine whether micronutrient intake has a causal impact on the chance of developing thyroid cancer. Methods: We used a Mendelian randomization (MR) analysis with two samples. Our circulation levels of Cu, Ir, Zn, Ca, VD, and VC were reflected by genetic variations reported from GWAS in individuals of European ancestry. For the GWAS outcome of thyroid cancer. Sensitivity studies that included MR-Egger, weighted median/mode tests, and a more open selection of variations at a genome-wide sub-significant threshold were added to our inverse-variance weighted (IVW) MR study. Results: Using the IVW approach, we did not find evidence that any of the micronutrients to thyroid cancer (Cu: odds ratio [OR = 0.88, p = 0.41]; Zn: odds ratio [OR = 0.87, p = 0.40]; Ir: odds ratio [OR = 1.18, p = 0.39]; Ca: odds ratio [OR = 1.12, p = 0.43]; VC: odds ratio [OR = 0.95, p = 0.22]; VD: odds ratio [OR = 0.89, p = 0.04]). The heterogeneity (p > 0.05) and pleiotropy (p > 0.05) testing provided confirmatory evidence for the validity of our MR estimates. Conclusion: This study does not provide evidence that supplementation with micronutrients including Cu, Ir, Zn, Ca, VD, and VC can prevent thyroid cancer.

Assessing the importance of nitric acid and ammonia for particle growth in the polluted boundary layer.

Aerosols formed and grown by gas-to-particle processes are a major contributor to smog and haze in megacities, despite the competition between growth and loss rates. Rapid growth rates from ammonium nitrate formation have the potential to sustain particle number in typical urban polluted conditions. This process requires supersaturation of gas-phase ammonia and nitric acid with respect to ammonium nitrate saturation ratios. Urban environments are inhomogeneous. In the troposphere, vertical mixing is fast, and aerosols may experience rapidly changing temperatures. In areas close to sources of pollution, gas-phase concentrations can also be highly variable. In this work we present results from nucleation experiments at -10 °C and 5 °C in the CLOUD chamber at CERN. We verify, using a kinetic model, how long supersaturation is likely to be sustained under urban conditions with temperature and concentration inhomogeneities, and the impact it may have on the particle size distribution. We show that rapid and strong temperature changes of 1 °C min-1 are needed to cause rapid growth of nanoparticles through ammonium nitrate formation. Furthermore, inhomogeneous emissions of ammonia in cities may also cause rapid growth of particles.

Nitrate Radicals Suppress Biogenic New Particle Formation from Monoterpene Oxidation.

Highly oxygenated organic molecules (HOMs) are a major source of new particles that affect the Earth's climate. HOM production from the oxidation of volatile organic compounds (VOCs) occurs during both the day and night and can lead to new particle formation (NPF). However, NPF involving organic vapors has been reported much more often during the daytime than during nighttime. Here, we show that the nitrate radicals (NO3), which arise predominantly at night, inhibit NPF during the oxidation of monoterpenes based on three lines of observational evidence: NPF experiments in the CLOUD (Cosmics Leaving OUtdoor Droplets) chamber at CERN (European Organization for Nuclear Research), radical chemistry experiments using an oxidation flow reactor, and field observations in a wetland that occasionally exhibits nocturnal NPF. Nitrooxy-peroxy radicals formed from NO3 chemistry suppress the production of ultralow-volatility organic compounds (ULVOCs) responsible for biogenic NPF, which are covalently bound peroxy radical (RO2) dimer association products. The ULVOC yield of α-pinene in the presence of NO3 is one-fifth of that resulting from ozone chemistry alone. Even trace amounts of NO3 radicals, at sub-parts per trillion level, suppress the NPF rate by a factor of 4. Ambient observations further confirm that when NO3 chemistry is involved, monoterpene NPF is completely turned off. Our results explain the frequent absence of nocturnal biogenic NPF in monoterpene (α-pinene)-rich environments.

Treatment of Meniere's disease with simultaneous triple semicircular canal occlusion and cochlear implantation.

OBJECTIVE: Report three cases of simultaneous triple semicircular canal occlusion (TSCO) and cochlear implantation (CI) as the treatment of intractable Meniere's disease (MD). CASE REPORTS: Patients with MD can present occasionally with intractable vertigo and profound sensorineural hearing loss (SNHL). TSCO and CI have been proposed to control vertigo and restore profound deafness in patients with MD separately. However, a few studies have reported simultaneous TSCO and CI in the same surgical procedure for the treatment of MD. In the present study, we described three patients with MD showing incapacitating vertigo and severe SNHL who underwent simultaneous TSCO and CI after examinations of auditory system, vestibular system, and imaging. Their symptoms were significantly alleviated during the follow-up period. CONCLUSION: The combined TSCO and CI remains a viable treatment option which is effective for the control of vertigo as well as the restoring of hearing in patients with MD.

Iodine oxoacids enhance nucleation of sulfuric acid particles in the atmosphere.

The main nucleating vapor in the atmosphere is thought to be sulfuric acid (H2SO4), stabilized by ammonia (NH3). However, in marine and polar regions, NH3 is generally low, and H2SO4 is frequently found together with iodine oxoacids [HIOx, i.e., iodic acid (HIO3) and iodous acid (HIO2)]. In experiments performed with the CERN CLOUD (Cosmics Leaving OUtdoor Droplets) chamber, we investigated the interplay of H2SO4 and HIOx during atmospheric particle nucleation. We found that HIOx greatly enhances H2SO4(-NH3) nucleation through two different interactions. First, HIO3 strongly binds with H2SO4 in charged clusters so they drive particle nucleation synergistically. Second, HIO2 substitutes for NH3, forming strongly bound H2SO4-HIO2 acid-base pairs in molecular clusters. Global observations imply that HIOx is enhancing H2SO4(-NH3) nucleation rates 10- to 10,000-fold in marine and polar regions.

Risk factors of incontinence-associated dermatitis in older adults: a protocol for systematic review and meta-analysis.

INTRODUCTION: Due to their ageing skin, older adults are more likely to develop incontinence-associated dermatitis (IAD). Although previous attempts to look at the risk factors for IAD in older adults were done, methodological barriers hindered an in-depth understanding. By investigating risk factors for IAD in the ageing population, the development of precise clinical interventions and guidance could be facilitated, which in turn would enhance patient care standards for incontinence management in this target group. To address this knowledge gap, this systematic review with meta-analysis aims to explore the major risk elements linked to IAD among older adults. METHODS AND ANALYSIS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols are adhered to in this systematic review and meta-analysis. To achieve its objectives, a comprehensive search strategy PubMed, Embase, Web of Science, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Medline, Chinese Scientific Journal Database (VIP database), WanFang Data Knowledge Service Platform, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, along with other relevant sources published until 18 July 2023 in both English and Chinese languages will be performed. The screening of articles, data abstraction and risk of bias evaluation will be done by two impartial reviewers. RevMan V.5.3 software will be used for data synthesis. The quality of the included study will be assessed using the Newcastle-Ottawa Quality Assessment tool and the Agency for Healthcare Research and Quality. The I 2 test will identify the heterogeneity. ETHICS AND DISSEMINATION: There is no need for ethical approval. Individual patient information or the rights of participants will not be compromised by this protocol. The findings will either be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42023442585.

The synergistic role of sulfuric acid, ammonia and organics in particle formation over an agricultural land.

Agriculture provides people with food, but poses environmental challenges. Via comprehensive observations on an agricultural land at Qvidja in Southern Finland, we were able to show that soil-emitted compounds (mainly ammonia and amines), together with available sulfuric acid, form new aerosol particles which then grow to climate-relevant sizes by the condensation of extremely low volatile organic compounds originating from a side production of photosynthesis (compounds emitted by ground and surrounding vegetation). We found that intensive local clustering events, with particle formation rates at 3 nm about 5-10 times higher than typical rates in boreal forest environments, occur on around 30% of all days. The requirements for these clustering events to occur were found to be clear sky, a low wind speed to accumulate the emissions from local agricultural land, particularly ammonia, the presence of low volatile organic compounds, and sufficient gaseous sulfuric acid. The local clustering will then contribute to regional new particle formation. Since the agricultural land is much more effective per surface area than the boreal forest in producing aerosol particles, these findings provide insight into the participation of agricultural lands in climatic cooling, counteracting the climatic warming effects of farming.

Cigarette smoking and thyroid cancer risk: A Mendelian randomization study.

BACKGROUND: The association between cigarette smoking and thyroid cancer has been reported in prospective cohort studies, but the relationship remains controversial. To investigate this potential correlation further, we employed Mendelian randomization methodology to evaluate the causative impact of smoking on thyroid cancer incidence. METHODS: From the genome-wide association study and Sequencing Consortium of Alcohol and Nicotine use, we obtained genetic variants associated with smoking initiation and cigarettes per day (1.2 million individuals). We also extracted genetic variants associated with past tobacco smoking from the UK Biobank (424,960 individuals). Thyroid cancer outcomes were selected from the FinnGen GWAS (989 thyroid cancer cases and 217,803 control cases). Sensitivity analyses employing various approaches such as weighted median, MR-Egger, and MR-pleiotropy residual sum and outlier (MR-PRESSO) have been executed, as well as leave-one-out analysis to identify pleiotropy. RESULTS: Using the IVW approach, we did not find evidence that any of the three smoking phenotypes were related to thyroid cancer (smoking initiation: odds ratio (OR) = 1.56, p = 0.61; cigarettes per day: OR = 0.85, p = 0.51; past tobacco smoking: OR = 0.80, p = 0.78). The heterogeneity (p > 0.05) and pleiotropy (p > 0.05) testing provided confirmatory evidence for the validity of our MR estimates. CONCLUSIONS: The MR analysis revealed that there may not exist a causative link between smoking exposure and elevated incidence rates of thyroid malignancies.

Fertility concerns in cancer patients: a bibliometric analysis via CiteSpace: A review.

Fertility concerns are a pervasive issue but very subtle in patients with cancer. Though various studies have focused on fertility concerns, limited research endeavor has been dedicated to bibliometric analysis. Given this, to visually analyze the hot frontier trends of research related to fertility concerns of patients with cancer using CiteSpace and provide new insights for future research in this field using the bibliometric method. We used CiteSpace software to retrieve the literature related to fertility concerns of patients with cancer in the Web of Science core collection database from the year of establishment to 2022 and conducted visual analysis in terms of authors, countries and regions, research institutions, and keywords. The search resulted in 201 valid articles, and the annual publication volume of literature related to fertility concerns in patients with cancer was generally on the rise; the country with the most publications was the United States, which also had the highest influence; the main research institution was Sloan Kettleson Cancer Research Center; the core research scholar was Jessica R. Gorman; the research hotspots mainly centered on quality of survival, women, survivorship, preservation, breast cancer, adolescence, and infertility. The results of this bibliometric study provide the current status and trends in the fertility concerns of patients with cancer and may help researchers identify the hotspots and frontier trends in this field.

Associations between cognition, anxiety, depression, and residual dizziness in elderly people with BPPV.

Objective: To investigate the associations between cognition, anxiety, depression, and residual dizziness after successful repositioning maneuvers in the elderly with benign paroxysmal positional vertigo (BPPV). Methods: We enrolled 40 elderly patients with BPPV in our outpatient department. We used the Dizziness Handicap Inventory (DHI), Visual Analog Scale (VAS), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder Questionnaire-7 (GAD-7) to assess the degree of dizziness, anxiety, and depression of participants before repositioning therapy, respectively. At the 1-week follow-up after BPPV treatment, each participant will be reassessed and divided into a group with residual dizziness (RD) and a group without residual dizziness (NRD) based on the follow-up DHI score. The Mini-Mental State Examination (MMSE) evaluated the cognitive function of the participants. Results: The age, gender, duration of BPPV, and involved semicircular canals in the two groups did not show a significant difference. The RD group scored significantly higher on the DHI (p = 0.006), GAD-7 (p < 0.001), and PHQ-9 (p = 0.002) before the repositioning treatment than the NRD group. The two groups had no significant difference in MMSE score (p = 0.381). Anxiety and depression scores before repositioning treatment significantly and positively correlated with follow-up DHI scores (r = 0.678 and 0.522, respectively), but the MMSE score did not significantly relate to it. The univariate linear regression showed that the DHI (p < 0.001), GAD-7 (p < 0.001), and PHQ-9 (p = 0.002) scores before treatment could predict residual dizziness. The multivariate linear regression showed that GAD-7 before treatment was the only significant predictor of residual dizziness (p < 0.001). Conclusion: The level of dizziness, anxiety, and depression before treatment can predict residual dizziness after successful repositioning maneuvers in the elderly with BPPV. Anxiety may be the strongest predictor of residual dizziness after successful repositioning treatment in elderly BPPV patients.

P300 Event-Related Potential Predicts Cognitive Dysfunction in Patients with Vestibular Disorders.

OBJECTIVE: Our aim was to determine the correlation between cognitive impairment and P300 event-related potential (ERP) in older adults with vertigo and imbalance, which further provides a reference for clinical diagnosis and patients' rehabilitation. METHODS: A total of 79 older adult patients with vertigo and imbalance in our outpatient department from January 2022 to December 2022 were selected and divided into the mild group (n = 20), moderate group (n = 39), and severe group (n = 20) according to the Dizziness Handicap Inventory (DHI). The auditory P300 component of event-related potentials (ERPs), Generalized Anxiety Disorder Questionnaire-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), and Mini-Mental State Examination (MMSE) were used to evaluate depression, anxiety, and cognitive function in these patients, respectively. RESULTS: The P300 latencies of the different severity groups were 292 ± 10 ms, 301 ± 8 ms, and 328 ± 5 ms, respectively, and the differences were statistically significant (p = 0.010). The P300 amplitudes of the different severity groups were 14.4 ± 2.6 µV, 3.9 ± 0.8 µV, and 5.1 ± 1.4 µV, respectively, and the differences were also statistically significant (p = 0.004). There was no statistically significant difference in the DHI evaluation or VAS visual simulation scoring between the two groups (p = 0.625, and 0.878, respectively). Compared with the short-course group, the long-course group showed prolonged P300 latency and decreased amplitude, higher scores in PHQ-9 and GAD-7, and lower scores in MMSE, and all the differences were statistically significant (p = 0.013, 0.021, 0.006, 0.004, and 0.018, respectively). CONCLUSION: Older patients with more severe symptoms of vertigo and imbalance are at higher risk of developing abnormal cognitive function. The P300 can be used as an objective neurophysiological test for the assessment of cognitive function relevant to elderly patients with vertigo and imbalance.

Emodin protects against intestinal dysfunction and enhances survival in rat model of septic peritonitis through anti-inflammatory actions.

BACKGROUND: Sepsis is a significant contributor to organ function damage or failure that results in intestinal dysfunction. Emodin (Emo) has received much attention for its notable anti-inflammatory and antibacterial properties. We aimed to explore the function of Emo on sepsis. METHODS: Sprague Dawley (SD) rats were pretreated with 20 or 40 mg/kg of Emo, followed by using cecal ligation and perforation to establish sepsis models. Hereafter, blood glucose levels, biochemical parameters, and inflammatory cytokines were measured. Additionally, ileal myeloperoxidase (MPO) activity was also measured. Diamine oxidase (DAO) level in plasma, fluorescein isothiocyanate-dextran 40 (FD-40) level in serum, bacteria number in blood and peritoneal fluid, histopathological changes of ileum, and tight junction (TJ) protein expressions in ileum were tested to evaluate the barrier function. Furthermore, CD4+ and CD8+ T cells' percentages were evaluated by flow cytometry. Finally, rats' survival rate was calculated as live rats divided by the total number of rats. RESULTS: Emo pretreatment not only decreased blood glucose level, but also downregulated triglyceride (TG), alanine aminotransferase (ALT), aspartate aminotransferase (AST), serum creatinine (SCr), blood urea nitrogen (BUN) contents for sepsis rats, especially for the high dose of Emo (p < .05). Furthermore, Emo inhibited MPO activity and inflammatory factor release (p < .05). Crucially, after Emo administration, the barrier function of ileum was enhanced, evidenced by the reduced DAO, FD-40 levels, decreased bacteria number, alleviated pathological damage in ileum and increased TJ protein expressions (p < .05). Rats treated with Emo exhibited increased percentages of CD8+ and CD4+ T cells (p < .05), as well as an improved survival rate. CONCLUSION: Emo exhibited a remarkable ability to attenuate sepsis by restoring intestinal dysfunction and improving survival rates, and the mechanism was closely related to anti-inflammatory properties, which provided new solid evidence for the use of Emo in treating sepsis.

The functional status of vestibular otolith and conductive pathway in patients with unilateral idiopathic sudden sensorineural hearing loss.

Background: The cause of idiopathic sudden sensorineural hearing loss (ISSNHL) remains unknown. It has been found that the functional status of the vestibular otolith is relevant to its prognosis; however, the evaluation of the vestibular otolith (intra-labyrinth) and superior and inferior vestibular nerve pathways (retro-labyrinth) in ISSNHL patients is not well-documented. Objective: This study aimed to investigate the functional status of the vestibular otolith and conductive pathway in patients with unilateral ISSNHL and analyze the correlations between vestibular evoked myogenic potentials (VEMPs) and hearing improvement after treatment. Methods: A total of 50 patients with unilateral ISSNHL underwent a battery of audio-vestibular evaluations, including pure tone audiometry, middle ear function, air-conducted sound-cervical VEMP (ACS-cVEMP), ACS-ocular VEMP (ACS-oVEMP), galvanic vestibular stimulation-cervical VEMP (GVS-cVEMP), and GVS-ocular VEMP (GVS-oVEMP). The results of auditory and VEMPs were retrospectively analyzed. Results: The abnormal rates of ACS-cVEMP, ACS-oVEMP, GVS-cVEMP, and GVS-oVEMP in affected ears were 30, 52, 8, and 16%, respectively. In affected ears, the abnormal rate of ACS-oVEMP was significantly higher than that of ACS-cVEMP (p = 0.025), while it was similar between GVS-cVEMP and GVS-oVEMP (p = 0.218). Compared with GVS-cVEMP, affected ears presented with a significantly higher abnormal rate of ACS-cVEMP (p = 0.005), and the abnormal rate of ACS-oVEMP was significantly higher than that of GVS-oVEMP (p < 0.001). No significant difference existed in latency and amplitude between affected and unaffected ears in ACS-VEMPs or GVS-VEMPs (p > 0.05). The abnormal rate of VEMPs in the poor recovery group was significantly higher than that of the good recovery group (p = 0.040). The abnormality percentages of ACS-oVEMP and GVS-oVEMP in the poor recovery group were significantly higher than that of the good recovery group (p = 0.004 and 0.039, respectively). The good hearing recovery rates were 76.47% in the normal VEMPs group, 58.33% in the intra-labyrinth lesion group, and 22.22% in the retro-labyrinth lesion group. Hearing recovery worsened as a greater number of abnormal VEMPs was presented. Conclusion: Besides Corti's organ, the impairment of otolithic organs was prominent in patients with ISSNHL. The normal VEMPs group had the highest rate of good recovery, followed by the intra-labyrinth lesion group and the retro-labyrinth lesion group presented with the lowest recovery rate. Abnormalities in ACS-oVEMP and/or GVS-oVEMP were indicators of a poor prognosis.

Co-ensiling of rice straw and distillers grains to increase methane production and maximise energy output.

High organic matter preservation during ensiling promotes material conversion and energy output. In this study, the effects of co-ensiling distillers grains and rice straw on methane production was evaluated, as distillers grains are highly acidic. For co-ensiling, distillers grains and rice straw were mixed to produce methane at five carbon/nitrogen (C/N) ratios. RD20 (C/N20) and RD25 (C/N25) were defined as high-distillers-grain groups and other mixed groups as low-distillers-grain groups. The results showed that Lactobacillus was enriched in RD25, with the highest lactic acid content reaching 54.0 g/kg of dry matter. The pH and organic dry matter loss of RD25 were lower than those of low-distillers-grain groups, but the result for lignocellulose degradation rate was reversed. An 8.6% increase in methane yield and 7.9% increase in energy output were achieved in RD25. Ensiling-anaerobic digestion systems of C/N25 provide high organic matter preservation and energy output.

Risk factors of incontinence-associated dermatitis among critically ill patients: A systematic review and meta-analysis.

Objectives: Incontinence-associated dermatitis (IAD) is increasingly found among critically ill patients, but the risk factors for IAD in these patients are currently unclear. The purpose of this meta-analysis was to identify the risk factors of IAD in critically ill patients. Methods: Web of Science, PubMed, EMBASE, and Cochrane Library were systemically searched until July 2022. The studies were selected based on inclusion criteria, and data were independently extracted by two researchers. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of the included studies. Odds ratios (ORs) and their associated 95% confidence intervals (CIs) were used to identify significant differences in the risk factors. The I 2 test was used to estimate the heterogeneity of studies, and Egger's test was used to assess the potential publication bias. Results: A total of 7 studies enrolling 1,238 recipients were included in the meta-analysis. Age ≥ 60 (OR = 2.18, 95% CI: 1.38~3.42), female sex (OR = 1.76, 95% CI: 1.32~2.34), dialysis (OR = 2.67, 95% CI: 1.51~4.73), fever (OR = 1.55, 95% CI: 1.03~2.33), vasoactive agent (OR = 2.35, 95% CI: 1.45~3.80), PAT score ≥ 7 (OR = 5.23, 95% CI: 3.15~8.99), frequency of bowel movement > 3times/d (OR = 5.33, 95% CI: 3.19~8.93), and liquid stool (OR = 2.61, 95% CI: 1.56~4.38) were the risk factors of IAD among critically ill patients. Conclusions: Many risk factors are related to IAD among critically ill patients. Nursing staff should pay more attention to evaluating the risk of IAD and enhance the care of high-risk groups.

Etiological classification and management of dizziness in children: A systematic review and meta-analysis.

Background: Dizziness in children, which could not be diagnosed at an early stage in the past, is becoming increasingly clear to a large extent. However, the recognition of the diagnosis and management remains discrepant and controversial due to their complicated and varied etiology. Central and peripheral vestibular disorders, psychogenic and systemic diseases, and genetic pathogeny constitute childhood etiological entities. Further understanding of the etiology and the prevalence of vertigo disorders is of crucial importance and benefit in the diagnosis and management of pediatric patients. Methods: This systematic review and meta-analysis were conducted by systematically searching Embase, PubMed, the Cochrane Library, CNIK, the Chinese Wan-Fang database, CBM, the Chinese VIP database, and the Web of Science for literature on childhood vertigo disorders published up to May 2022. The literature was evaluated under strict screening and diagnostic criteria. Their quality was assessed using the Agency for Healthcare and Research Quality (AHRQ) standards. The test for homogeneity was conducted to determine the fixed effects model or random-effect model employed. Results: Twenty-three retrospective cross-sectional studies involving 7,647 children with vertigo disorders were finally included, with an AHRQ score >4 (high or moderate quality). Our results demonstrated that peripheral vertigo (52.20%, 95% CI: 42.9-61.4%) was more common in children than central vertigo (28.7%, 95% CI: 20.8-37.4%), psychogenic vertigo (7.0%, 95% CI: 4.8-10.0%), and other systemic vertigo (4.7%, 95% CI: 2.6-8.2%). The five most common etiological diagnoses associated with peripheral vertigo included benign paroxysmal vertigo of childhood (BPVC) (19.50%, 95% CI: 13.5-28.3%), sinusitis-related diseases (10.7%, 95% CI: -11.2-32.6%), vestibular or semicircular canal dysfunction (9.20%, 95% CI: 5.7-15.0%), benign paroxysmal positional vertigo (BPPV)(7.20%, 95% CI: 3.9-11.5%), and orthostatic dysregulation (6.8%, 95% CI: 3.4-13.0%). Vestibular migraine (20.3%, 95% CI: 15.4-25.2%) was the most seen etiological diagnosis associated with central vertigo in children. In addition, we found the sex-based difference influenced the outcome of psychogenic vertigo and vestibular migraine, while there was no significant difference in other categories of the etiology. For the management of vertigo, symptomatical management is the first choice for most types of vertigo disorder in pediatrics. Conclusion: Complex etiology and non-specific clinical manifestations of vertigo in pediatrics are challenging for their diagnoses. Reliable diagnosis and effective management depend on the close cooperation of multiple disciplines, combined with comprehensive consideration of the alternative characteristics of vertigo in children with growth and development.

Study on the predictive value of MHR combined with thromboelastography parameters for acute cerebral infarction in athlete players

Aims: To investigate the predictive value of peripheral blood monocyte count and high density lipoprotein cholesterol (HDL-C) ratio (monocyte/HDL-C, MHR) combined with thromboelastography (TEG) related parameters in acute Cerebral infarction (ACI). Methods: The study group included 201 patients with ACI, and the comparison group included 201 patients with non-ACI. Using dispersion analysis, changes in MHR and TEG were compared between the two groups. Using logistic regression analysis, valuable measures of model building were screened. Using receiver operating characteristic (ROC) curves, the predictive effect of a combination of single and multiple indices on ACI was evaluated. Based on NIHSS scores, the research team was also divided into a mild nerve injury group (152 cases) and a moderate to severe nerve injury group (49 cases). Compare the changes in the two groups of indicators. Correlations between NIHSS scores and each index were analyzed by pearson correlation. Reasults: Lymphocyte count, monocyte count, MHR, angle, MA, G and A30 were higher in the study group than in the control group. HDL-C, NLR, R and K values were lower in the study group than in the control group, and the differences were statistically significant (P<0.05). Among the indicators, MHR had the highest diagnostic concordance rate and area under the curve (AUC) (0.806 and 0.883, respectively), the highest sensitivity (0.891) for the count of monocyte , and the highest R-value specificity (0.776). Logistic regression analysis showed that MHR>0.367, monocyte count >0.38×109/L, A30>63.1mm and R value<5.0min were independent risk factors for ACI. The 4-factor regression equation has been established: logit(P)=-2.19+1.541* monocyte count -1.731*R+1.466*A30+2.040*MHR. (AU)

Abnormal posterior semicircular canal function may predict poor prognosis in patients with severe and profound ISSNHL.

Background: Severe and profound idiopathic sudden sensorineural hearing loss (ISSNHL) generally leads to unfavorable prognosis, and has a considerable impact on patient quality of life. However, related prognostic factors remain controversial. Objective: To elaborate the relationship between vestibular function impairment and the prognosis of patients with severe and profound ISSNHL, and investigated the relevant factors affecting prognosis. Methods: Forty-nine patients with severe and profound ISSNHL were divided into good outcome group [GO group, pure tone average (PTA) improvement > 30 dB] and poor outcome group (PO group, PTA improvement ≤ 30 dB) according to hearing outcomes. The clinical characteristics and the proportion of abnormal vestibular function tests in these two groups were analyzed by univariate analysis, and multivariable logistic regression analysis was performed for parameters with significant differences. Results: Forty-six patients had abnormal vestibular function test results (46/49, 93.88%). The number of vestibular organ injuries was 1.82 ± 1.29 in all patients, with higher mean numbers in PO group (2.22 ± 1.37) than in GO group (1.32 ± 0.99). Univariate analysis revealed no statistical differences between the GO and PO groups in terms of gender, age, side of the affected ear, vestibular symptoms, delayed treatment, instantaneous gain value of horizontal semicircular canal, regression gain value of vertical semicircular canal, abnormal rates of oVEMP, cVEMP, caloric test and vHIT in anterior and horizontal semicircular canal, however, significant differences were found in the initial hearing loss and abnormal vHIT of posterior semicircular canal (PSC). Multivariable analysis revealed that only PSC injury was an independent risk factor for predicting the prognosis of patients with severe and profound ISSNHL. Patients with abnormal PSC function had worse initial hearing impairment and prognosis than patients with normal PSC function. The sensitivity of abnormal PSC function in predicting poor prognosis in patients with severe and profound ISSNHL was 66.67%, specificity was 95.45%, and positive and negative likelihood ratios were 14.65 and 0.35, respectively. Conclusion: Abnormal PSC function is an independent risk factor for poor prognosis in patients with severe and profound ISSNHL. Ischemia in the branches of the internal auditory artery supplying the cochlea and PSC may be the underlying mechanism.